Pediatric Anesthesia最新文献

{"title":"Case Series of Anesthetic Management of Gene Therapy in Children With Aromatic L-Amino Acid Decarboxylase Deficiency.","authors":"Simon Clariot, Séverine Gras, Laurent Goetz, Christophe Boulloud, Julie Bonheur, Pia Vayssiere, Vincent D'Hardemare, Claudia Ravelli, Nathalie Dorison, Jean-Michel Devys","doi":"10.1111/pan.15060","DOIUrl":"10.1111/pan.15060","url":null,"abstract":"<p><strong>Background: </strong>Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare life-threatening inborn error of neurotransmitter biosynthesis. It is characterized by deficient biosynthesis of neurotransmitters dopamine and serotonin, leading to catecholamines deficiency and sympathetic deprivation, while the parasympathetic system remains functional. Since 2012, gene therapy has led to clinical improvements in symptoms and motor function with a severe phenotype. General anesthesia of children with AADC deficiency is challenging.</p><p><strong>Aim: </strong>Describe prolonged anesthesia management of children with aromatic L-amino acid decarboxylase deficiency undergoing stereotactically guided gene therapy.</p><p><strong>Methods: </strong>Prospective reporting of epidemiologic and anesthetics data of four children consecutively undergoing magnetic resonance-guided direct delivery of an AADC vector for gene therapy under general anesthesia.</p><p><strong>Results: </strong>General anesthesia was initiated with sevoflurane and ketamine and rocuronium was the neuromuscular blocking agent of choice throughout the procedures. Intraoperative hemodynamic monitoring included an arterial line. All children required low doses of diluted norepinephrine during the intraoperative period. No dysautomic episodes as well as no episode of severe hypotension and no severe hypoglycemia were reported throughout the procedures. Vasopressor support was discontinued for all children at the end of the procedures. Moreover, no peroperative and postoperative effects secondary to AADC vector injection were noted.</p><p><strong>Conclusion: </strong>Using an anesthetic plan based on atropine, ketamine, sevoflurane, and a titrated infusion of norepinephrine, prolonged anesthesia appeared to be safe and reproductible in this population.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"316-320"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial.","authors":"T Wesley Templeton, Gijo Alex, Jean D Eloy, Lindsay Stollings, Richard J Ing, Eric C Cheon, Kumar Belani, Ilan Breskin, Peter S Sebel, Brad M Taicher","doi":"10.1111/pan.15057","DOIUrl":"10.1111/pan.15057","url":null,"abstract":"<p><strong>Background: </strong>In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.</p><p><strong>Aims: </strong>The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.</p><p><strong>Methods: </strong>Participants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45-60 during the maintenance period. In the control arm, clinicians were blinded to the BIS value. Primary outcome was mean end-tidal sevoflurane concentration during maintenance phase of anesthesia. Secondary assessments included time to discharge and the readiness and quality of recovery as assessed by the Pediatric Anesthesia Emergence Delirium scale, the modified Aldrete Score, and the Wong-Baker FACES scale. An intention-to-treat analysis was used to analyze and compare groups.</p><p><strong>Results: </strong>A total of 180 participants were randomized. Following randomization, 10 participants did not undergo any study procedures, leaving 84 participants in the BIS guided group and 86 participants in the control group. Across all age groups, the average end-tidal sevoflurane concentration was less in the BIS guided group compared to control (4-8 years: 2.2% ± 0.3% vs. 2.4% ± 0.4%, -0.3% [-0.4%, -0.1%]; 9-12 years: 1.7% ± 0.5% vs. 2.1% ± 0.6%, -0.4% [-0.7%, -0.1%]; 13-18 years: 1.6% ± 0.4% vs. 1.9% ± 0.5%, -0.3% [-0.5%, -0.1%]). No differences in recovery outcomes between treatment groups were observed.</p><p><strong>Conclusions: </strong>In pediatric participants, the BIS guided group reported a lower average end-tidal sevoflurane concentration compared to control, though no significant differences in recovery profile were noted.</p><p><strong>Clinical implications: </strong>The Bispectral Index (BIS) is a processed EEG tool that can be used to titrate general anesthesia to achieve desired anesthetic depth. Brain monitoring with BIS resulted in lower average end-tidal sevoflurane concentrations in children aged 4-18 years undergoing general anesthesia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04810481.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"277-286"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NARS1-Related Disorder-An Orphan Disease.","authors":"Neha Hasija, Jessica Lees","doi":"10.1111/pan.15071","DOIUrl":"10.1111/pan.15071","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"325-326"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authorship: The Editors' Perspective.","authors":"Andrew Davidson","doi":"10.1111/pan.15072","DOIUrl":"10.1111/pan.15072","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"264-266"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ball Valve Gas Trapping in Pediatric One-Lung Ventilation: Not All Ventilation Is Loss of Isolation.","authors":"Anthony M-H Ho, Julie Zalan, Amanda Jasudavisius, Fraser Johnson, Glenio B Mizubuti","doi":"10.1111/pan.15067","DOIUrl":"10.1111/pan.15067","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"327-328"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Awake Craniotomy: An Educational Review.","authors":"Maria Nabil Henry, Maryam N Shahin, Ian Stevens, Jessica Calvert, Dana Dharmakaya Colgan, Michael Vega, Kelly Collins","doi":"10.1111/pan.15075","DOIUrl":"10.1111/pan.15075","url":null,"abstract":"<p><strong>Background: </strong>Awake craniotomies with functional cortical mapping are performed to minimize post-operative deficits from the resection of lesions adjacent to eloquent cortex. The procedure is well-established in the adult patient population and is increasingly applied to well-selected pediatric patients. A review of recent literature demonstrated that the most commonly reported anesthetic techniques were \"asleep-awake-asleep\" protocols that relied on propofol, remifentanil, or fentanyl.</p><p><strong>Main article: </strong>This educational review discusses the unique challenges that face the anesthesiology and neurosurgical teams when working with the pediatric population. To further illustrate pediatric-specific considerations, a case of a 9-year-old boy who underwent a resection of a large left peri-rolandic ependymoma is presented, including his multidisciplinary pre-operative, intra-operative, and post-operative care.</p><p><strong>Conclusion: </strong>Awake craniotomies can safely be performed in the pediatric population with appropriate patient selection, planning, and a multi-disciplinary approach.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"270-276"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Picks for the Pediatric Anesthesia Article of the Day: October 2024.","authors":"Melissa Brooks Peterson, Myron Yaster, Justin L Lockman","doi":"10.1111/pan.15062","DOIUrl":"10.1111/pan.15062","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"323-324"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacokinetic and Physiological Concepts Relevant for Determining Sevoflurane Dose.","authors":"James D Morse, Brian J Anderson","doi":"10.1111/pan.15077","DOIUrl":"10.1111/pan.15077","url":null,"abstract":"","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"267-269"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.","authors":"Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop","doi":"10.1111/pan.15059","DOIUrl":"10.1111/pan.15059","url":null,"abstract":"<p><strong>Background: </strong>Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.</p><p><strong>Aims: </strong>We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.</p><p><strong>Methods: </strong>This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.</p><p><strong>Results: </strong>150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).</p><p><strong>Conclusion: </strong>TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.</p><p><strong>Trial registration: </strong>German Clinical Trial Register: DRKS00028271.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"310-315"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucositis Pain and Its Temporal Relationship to White Cell Count.","authors":"Claire Douglas, James D Morse, Brian J Anderson","doi":"10.1111/pan.15063","DOIUrl":"10.1111/pan.15063","url":null,"abstract":"<p><strong>Background: </strong>Children who have received chemotherapy and/or radiotherapy treatment resulting in neutropenia can suffer painful mucositis. We explored the relationship between pain score and white cell count in children with mucositis due to immunosuppression and assessed the influence of opioid and ketamine analgesia.</p><p><strong>Methods: </strong>Children with mucositis nursed in the pediatric oncology and hematology ward were invited to partake in this observational study following referral to the pediatric pain service for intravenous analgesia. Pain scores, white cell count, neutrophil count, and analgesia requirements were recorded daily until intravenous analgesia was either stopped or transitioned to oral analgesia. Data were analyzed using nonlinear mixed effects models that sought a relationship between white cell count and pain score using a sigmoid maximal effect (E_MAX) model. The impact of analgesic use on pain score was determined. The temporal relationship between white cell count and pain score was characterized by using a delayed effect model with an equilibration half-time.</p><p><strong>Results: </strong>Fifty children were enrolled in the study from January 2022 to December 2023. The equilibration half-time relating the rise in white cell count and pain response was 0.29 days. The initial pain score (estimated in those children already started on treatment with paracetamol and tramadol) was 6.3 (maximum pain 10). The maximum pain reduction was 59% of that initial pain score. Morphine and ketamine further reduced pain; the maximum response for opioids was 38% reduction and that for ketamine was 11%.</p><p><strong>Conclusion: </strong>Pain relief from mucositis is related to an increase in white cell count after a period of severe neutropenia, where white cell count is a surrogate for neutrophil count. There is a delay in analgesic response of approximately 1 day. This analgesic response to increasing white cell count had greater dominance than analgesia achieved using either opioids or ketamine.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":"302-309"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}